For up-to- date team by team 1acs go here

Draft Monday, July 23

Text: The United States federal government should expand the Center for Disease Control’s Global Disease Detection Program in Sub-Saharan Africa. We’ll clarify.

Contention One – Inherency

Initially note, countries in Sub-Saharan Africa can’t afford cross-border disease surveillance technology – that means they misdiagnose diseases and perpetuate disease spread

Jakob Zinsstag et al, Department of Public Health and Epidemiology at the Swiss Tropical Institute, 2007
[“Human benefits of animal interventions for zoonosis control,” U.S. National Center for Infectious Diseases, April 1, Lexis] Rein
The spread of highly pathogenic avian influenza is a global threat to all countries that have a poultry industry, semicommercial poultry production, or backyard poultry operations and has already caused enormous economic losses (19). Moreover, the risk for human pandemic influenza originating from highly pathogenic avian influenza in conjunction with human influenza A virus is very high, with an estimate of >100,000 deaths for the United States alone (20). To implement disease prevention and control measures, early identification of emerging patterns of disease is necessary and uses economic methods to determine which mix of measures is most cost-effective. Resource-limited countries in Africa are almost devoid of surveillance capacity and efficient early warning systems, which would be crucial. Surveillance of cross-border diseases cannot be restricted to countries that have the funds. High-income countries would ultimately benefit by providing funding for surveillance and control to low-income countries. Comprehensive economic assessment of this issue are, however, lacking so far. Awareness, Knowledge, and Information Many countries, especially those with resource constraints and those in sub Saharan Africa, lack information on the distribution of zoonotic diseases. Risks for zoonoses are considered negligible compared with those for diseases of higher consequence because the societal consequences of zoonoses are not recognized by the individual sectors. For example, outbreaks of Rift Valley fever in persons in Mauritania were mistakenly identified as yellow fever. The correct diagnosis was made only after public health services contacted livestock services, which informed them of abortions in cattle (21). In resource limited and transitioning countries, many zoonoses are not controlled effectively because adequate policies and funding are lacking. However, transmission of zoonoses to humans can already be greatly reduced by health information and behavior. Authorities in Kyrgyzstan, for example, have started an information campaign to reduce brucellosis transmission to small-ruminant herders by encouraging them to wear gloves for lambing and to boil milk before consuming. Interventions in livestock should always be accompanied by mass information, education, and communication programs.

Contention Two – Disease

New diseases are inevitable and are appearing constantly

Declan Butler, Freelance Journalist, 2006
[“Disease Surveillance needs a revolution,” Nature, 3/1, http://www.nature.com/news /2006/060227/full/440006a.html]
Many hope that resources pumped into avian flu will benefit the surveillance of emerging diseases generally by strengthening infrastructure. But the money available so far is only a start. And the rate at which new diseases appear — currently around one a year — is increasing. Mark Woolhouse, an epidemiologist at the University of Edinburgh, UK, has analysed all recognized human pathogens and he suggests that this rise is mainly due to changes in land use and the way that people live. Of the 117 emergent human diseases that he has studied, more than half jumped from animals. "The world has to get to grips with the fact that what is happening now is going to happen repeatedly," says Roeder. "We have to develop a global structure to tackle emerging diseases.

Ineffective surveillance in Africa prevents global understanding of future disease spread and current disease containment—accurate analysis allows for effective local response

GAO, United States General Accounting Office, 2001
[“Challenges in Improving Infectious Disease Surveillance Systems,” August]
Weaknesses in developing country systems reduce the ability of public health authorities at every level to understand and control infectious disease threats. These shortcomings limit the success of ambitious international programs such as the polio eradication effort, and impair the routine surveillance of other diseases and the identification and control of outbreaks, newly emerging diseases, and antimicrobial resistance. The surveillance achievements recorded by programs such as the polio eradication effort have been possible only because intensive international assistance has been given to developing countries so that they can participate in these programs. In spite of this assistance, poor surveillance in developing countries has continued to limit the ability of these programs to achieve their goals. For example, according to CDC, four countries in southern Africa were unable to meet international expectations in 1999 for detecting cases of acute flaccid paralysis, a key indicator of polio surveillance quality. Seven countries in the region fell short of the targeted 80-percent rate for collecting stool samples from suspected cases. The African region as a whole performed more poorly than any other, detecting less than the target number of potential polio cases and attaining less than the 90-percent goal for completeness of reporting. According to CDC, completing the global eradication effort is complicated by systemic weaknesses in the remaining endemic areas, which are located primarily in sub-Saharan Africa and South Asia.27 Ineffective routine surveillance seriously compromises the international community’s ability to understand global disease burdens and trends. As already indicated with regard to yellow fever, cholera, and dengue, the global incidence of many diseases is unknown. One WHO official noted that health authorities in Equatorial Guinea, which lies within the yellow fever endemic zone of Africa, had informed him that their country has never experienced an outbreak of yellow fever. This statement cannot be disproved because no surveillance for yellow fever exists in Equatorial Guinea. Even when adequate data exist to identify gross trends, the data generally are not adequate for in-depth analyses or informed decisions about targeting resources to achieve specific control objectives. Developing countries often cannot investigate or address outbreaks on their own. CDC’s investigative expertise, including laboratory support, is comparatively rare in the rest of the world. Many of the African surveillance assessments we reviewed indicated that outbreaks there are often not thoroughly investigated, if they are investigated at all. Health officials in countries we visited and at WHO headquarters in Geneva noted that serious outbreaks strain developing countries’ relatively weak public health systems, requiring them to request international assistance to cope. For example, India experienced an outbreak of plague in 1994 that resulted in hundreds of cases across the country, 56 deaths, and over a billion dollars in economic damage from the travel restrictions and trade embargoes imposed by other countries. The outbreak was severe in part because India had largely discontinued surveillance for plague. Health authorities did not respond to initial complaints of flea infestation and did not take appropriate measures to contain the outbreak. The disease spread to crowded urban slums where it progressed unchecked to its highly contagious, pneumonic form and became a serious national problem.

Sub-Saharan epidemics kill 27 million annually
Matthew Carlberg, Marine Corps Command And Staff Coll Quantico va, 2002
[July, http://stinet.dtic.mil/oai/oai ?&verb=getRecord&metadataPrefix �16�html&identifier�17�ADA403988]
Epidemics threaten national security by impacting the economic, political, and social aspects of national power. The AIDS epidemic in Sub-Saharan Africa bears stark witness to the magnitude of this threat. It also offers the opportunity for prospective study of the relationship between epidemics, state failures, and wars. There are roughly 54 million deaths annually worldwide from infectious diseases. Half of these deaths occur in Sub-Saharan Africa. The litany of resurgent and emerging infectious diseases, coupled with the phenomenon of antibiotic resistance, bring to light the magnitude of the threat both to national security and deployed forces.

For example, surveillance in Sub-Saharan Africa is insufficient to contain the bird flu – Sub-Saharan Africa is a critical region to prevent spread and mutation

Tiaji Salaam-Blyther, Coordinator Foreign Affairs, Defense, and Trade Division of the Congressional Research Service, 2006
[U.S. and International Responses to the Global Spread of Avian Flu: Issues for Congress, 1/9, http://fpc.state.gov/documents /organization/59025.pdf]
Global Disease Surveillance A number of analysts have argued that due to insufficient investment in disease surveillance and health care in many of the countries where H5N1 is endemic, a pandemic may progress before it is discovered. In this view, ill-equipped surveillance systems will be slow to determine the source of a pandemic, evaluate the rate of viral transmission, ascertain whether H5N1 has become efficiently transmissible among humans, or rate the effectiveness of anti-flu initiatives. Senate Majority Leader Bill Frist has proposed $1 billion for a real-time international threat detection system.126 USAID and other U.S. government officials suspect that the lack of documented human cases of H5N1 in Laos has more to do with inadequate surveillance and reporting systems than an absence of infection.127 Some health experts believe that H5N1transmission could already be underway in Laos, since surrounding countries have already had human and animal outbreaks. Key U.S. agencies and international organizations have determined that Laos is a country that needs critical prevention, monitoring, and surveillance support in order to prevent full-blown human-to-human transmission of H5N1 that could emerge and sweep across the region without warning.128 Some experts have expressed increasing concern about the capacity of poorer countries that have not yet had H5N1 cases to effectively contain the spread of the virus and plan for pandemic influenza, particularly in sub-Saharan Africa. FAO has recently warned that the risk of H5N1 spreading to the Middle East and Africa has markedly increased. FAO is particularly wary of the virus reaching Eastern Africa, as the surveillance capacities and veterinary services in those countries are limited. According to Reuters, a WHO representative declared that an H5N1 outbreak would likely be missed in Africa, as bird nutrition is poor and high mortality among poultry is common. Concurrently, human cluster cases are likely to be missed due to poor surveillance systems. South Africa is reportedly the only country in sub-Saharan Africa to have drawn up a pandemic preparedness plan.129 Some experts fear that an unabated H5N1 outbreak in East Africa could make the bird flu endemic there. “If the virus were to become endemic in eastern Africa, it could increase the risk that the virus would evolve through mutation or reassortment into a strain that could be transmitted to and between humans.”130

Mutation of bird flu is inevitable and a pandemic could be triggered at any moment

Satish Chandra, Deputy National Security Advisor of India – Center for Strategic Decision Research, 2004
[Global Security: A broader Concept for the 21st Century, 5/7, http://www.csdr.org/2004book /chandra.htm]
If the possibility of the collapse of the thermohaline circulation system is alarming, the possibility of a human-to-human transmittable bird flu pandemic is a nightmare. What makes it so frightening is the fact that it could happen at any time and that we are ill prepared to face it. At current mortality rates, it could result in the sudden death of 15 to 20 percent of mankind. The most severe health crisis in recent years in terms of numbers of deaths was the 1918–1919 influenza epidemic, which in the space of one year caused an estimated 40 million deaths worldwide. Begun in Kansas in March 1918, the epidemic spread to Europe and then to India, Australia, and New Zealand. The virulence and mortality rate of the first wave of the disease, in the spring of 1918, was only slightly above normal levels but the second wave, which began in the fall of 1918, was extraordinarily deadly, with mortality rates of 5 to 20 percent above normal levels. It is believed that the fall strain of the virus came about through genetic mutation and that the genetic structure of the virus was a form of a swine and avian influenza strain. Since 1918, the world has seen several influenza outbreaks, most notably the 1957 Asian flu outbreak and the 1968 Hong Kong flu outbreak, each of which killed a million people. While WHO now has an Influenza Surveillance Program in place as well as an Influenza Pandemic Preparedness Plan, we still need to examine the possibility of the highly pathogenic H5N1 bird flu becoming transmittable from human to human, the outcome of such a situation, and what must be done to address the possibility. Since the end of 2003, outbreaks of the highly pathogenic H5N1 strain of avian influenza, or bird flu, have occurred in eight Asian countries, resulting in the loss of 100 million poultry birds. The implications for human health are worrisome because of the extreme pathogenic nature of this virus—it has the capability to infect humans and cause severe illness, with mortality rates of 60 to 70 percent. It has already infected humans three times in the recent past: In 1997 and 2003 in Hong Kong and in 2004 in Vietnam and Thailand. So far the disease has been transmitted only to humans who came in contact with dead or diseased poultry—it has not yet mutated to being capable of human-to-human transmission. The Likelihood of a Pandemic Since the H5N1 strain has not been eliminated from its avian hosts, it is obviously endemic. The risk, therefore, that the virus could take on a new form that would make it capable of human-to- human transmission is considerable, especially because mass vaccinations of chickens, aimed at mitigating the disaster facing poultry farmers, has allowed the virus to continue to circulate among the vaccinated birds. It can thus linger indefinitely in poultry, making the gene mutation required to make it transmittable from human to human an even greater possibility. It could be said that there are three prerequisites for the start of a pandemic: 1) a new virus must emerge against which the general population has little or no immunity; 2) the new virus must be able to replicate in humans and cause disease; and 3) the new virus must be efficiently transmitted from one human to another. Dr. Anarji Asamoa Baah, Assistant Director General, Communicable Diseases, WHO, asserts that, regarding H5N1, the first two prerequisites have already been met, and it is known that the virus can become more transmittable via two mechanisms, “adaptive mutation” and “genetic re-assortment.” Dr. Baah has further contended that re-assortment of H5N1 with a human influenza virus can take place in humans without prior adaptation in other species such as swine. It is clear, therefore, that 1) the H5N1 virus will continue to circulate for a very long time in poultry birds; 2) the threat to public health will be there as long as the virus continues to circulate in poultry birds; 3) should the virus become transmittable from human to human, the consequences for human health worldwide, in the words of Dr. Baah, “could be devastating;” and 4) the world needs to be prepared to respond to the next influenza outbreak. During an Influenza Pandemic Preparedness meeting in Geneva in March 2004, the head of the World Health Organization warned, “We know another pandemic is inevitable. It is coming…we also know that we are unlikely to have enough drugs, vaccines, healthcare workers, and hospital capacity to cope in an ideal way.” On the basis of an epidemiological model project, WHO scientists predict that an influenza pandemic will result in 57 million to 132 million outpatient hospital visits, 1 million to 2.3 million admissions, and between 280,000 and 650,000 deaths in less than two years. The impact on poor nations would be much greater. But I submit that these projections are gross underestimates given the fact that the 1918–1919 influenza epidemic, with mortality rates of a maximum of 20 percent above normal level, caused as many as 40 million deaths. With mortality rates in excess of 60 percent, the H5N1 virus is bound to be much more deadly, particularly because in today’s world of air connectivity, the spread of H5N1 would be much more rapid than that of the 1918 influenza epidemic. Indeed, the death toll could run into hundreds of millions.

Disease surveillance, labs, and CDC expertise are key to preventing the rapid spread of bird flu

Stephen B. Blount, MD, MPH, Director – Office for Global Health, 2007
[5/2, http://www.hhs.gov/asl/testify /2007/05/t20070502a.html]
Currently, the US and the rest of the world are facing a very real threat posed by the highly pathogenic H5N1 avian influenza virus. Our experience with SARS showed us how a highly infectious disease in a remote region of the world can spread in a matter of days and weeks. Thanks to the rapid and constant movement of people and commodities, pathogens can hitch rides on airplanes and boats and slip across national borders unnoticed. The key to interrupting these pathogenic journeys is early detection as close to the source as possible. An estimated 60% of all known human infectious diseases and approximately 75% of all recently recognized emerging infectious diseases affecting humans are of animal origin. We witnessed sobering evidence of the health impact of the human-animal interface during our rapid multidisciplinary response to the large epidemic of potentially fatal Rift Valley fever virus earlier this year in east Africa. Additional disease surveillance tools, laboratory capacity, and CDC expertise deployed abroad can rapidly improve our ability to recognize and intervene to contain emerging threats—including a possible avian influenza pandemic—before they become significant problems within U.S. borders. To prepare for a pandemic of influenza, key issues we need to address are appropriate training and exercising of rapid response teams to identify, investigate, and contain local outbreaks. We also need to be able to trust that we have the most accurate and reliable information about influenza viruses and novel human influenza cases—through strong and established surveillance systems, laboratory capacity, and communication channels so we can respond effectively.

Bird flu transmissions spread globally, instantly killing a billion

Satish Chandra, Center for Strategic Decision Research, 2004
[Global Security: A broader Concept for the 21st Century, May 7th http://www.csdr.org/2004book /chandra.htm]
This scenario, as frightening as it is, pales in comparison with what could overtake us by 2007 if the highly pathogenic form of bird flu “H5N1” becomes transmittable human to human; all it would take for this to happen is a simple gene shift in the bird flu virus, which could happen any day. In a globalized world linked by rapid air travel, the disease would spread like a raging forest fire. If it did, it would overwhelm our public health system, cripple our economies, and wipe out a billion people within the space of a few months—a 60 percent mortality rate is estimated.

Expanding human and animal disease surveillance is necessary to link the two together, improving the effectiveness of targeting and the containing disease

T. Kuiken, Department of Virology, Erasmus MC, 2005
[“Pathogen Surveillance in Animals,” Science Magazine, Vol. 309. no. 5741, pp. 1680 – 1681, http://www.sciencemag.org/cgi /content/full/309/5741/1680 #AFF1] Rein
The tasks of the expert working group should include identifying the largest gaps in current surveillance systems in humans, domestic animals, and wildlife and determining the most cost-effective methods to fill them (e.g., sampling of animals at live animal markets, game farms, and ports of entry; establishment of systems for adequate preservation of samples from site of collection to the laboratory); identifying political barriers to effective surveillance (e.g., conflicting mandates of responsible authorities) and determining methods to deal with them appropriately (e.g., an international program of insurance against economic losses that may be triggered by rapid and transparent reporting); determining practical ways to integrate human and animal surveillance at the national and international level (including data management, communication networks, and regional laboratory networks); facilitating development and distribution of validated diagnostic tests for rapid and sensitive screening of samples for zoonotic pathogens in the full range of potential host species; and encouraging scientists and funding agencies to study the underlying mechanisms of disease emergence in order to find new methods to deal with this problem. We estimate the annual start-up costs for such a working group at US$4 to $5 million for the first 3 years, based on a core group of 10 people with broad knowledge of human, domestic animal, and wildlife health. Making use of the worldwide expertise in the relevant disciplines, this group would design and implement a global animal surveillance system for zoonotic pathogens. The costs of this system would depend in part on the risk that human society is willing to take, but would be only a fraction of the savings made by early detection and rapid response to emerging pathogens. Zoonotic pathogens do not respect national borders, so it is in the best interests of wealthy nations to invest in improved animal surveillance programs in all parts of the world. Emerging diseases are a major challenge to the biological safety of the world in the 21st century. Renewed effort, resources, and scientific innovations, as well as new degrees of integration are required to meet this challenge. Linking comprehensive pathogen surveillance of wild and domestic animals--the principal source of emerging infections--with public health surveillance at the national and international level, and improving the quality and coverage of these surveillance programs, will make an important and essential contribution to the detection and control of emerging zoonotic infections.

Surveillance can halt the transformation of animal diseases to future human epidemics by catching the disease early and creating disease databases to better understand and diagnose future diseases

Nathan D. Wolfe et al, Department of Epidemiology at UCLA, 2007
[“Origins of major human infectious diseases,” Nature 447, 279-283, May 17, http://www.nature.com/nature /journal/v447/n7142/full /nature05775.html#a1] Rein
Most major human infectious diseases have animal origins, and we continue to be bombarded by novel animal pathogens. Yet there is no ongoing systematic global effort to monitor for pathogens emerging from animals to humans. Such an effort could help us to describe the diversity of microbial agents to which our species is exposed; to characterize animal pathogens that might threaten us in the future; and perhaps to detect and control a local human emergence before it has a chance to spread globally. In our view, monitoring should focus on people with high levels of exposure to wild animals, such as hunters, butchers of wild game, wildlife veterinarians, workers in the wildlife trade, and zoo workers. Such people regularly become infected with animal viruses, and their infections can be monitored over time and traced to other people in contact with them. One of us (N.D.W.) has been working in Cameroon to monitor microbes in people who hunt wild game, in other people in their community, and in their animal prey15. The study is now expanding to other continents and to monitor domestic animals (such as dogs) that live in close proximity to humans but are exposed to wild animals through hunting and scavenging. Monitoring of people, animals, and animal die-offs16 will serve as an early warning system for disease emergence, while also providing a unique archive of pathogens infecting humans and the animals to which we are exposed. Specimens from such highly exposed human populations could be screened specifically for agents known to be present in the animals they hunt (for example, retroviruses among hunters of non-human primates), as well as generically using broad screening tools such as viral microarrays17 and random amplification polymerase chain reaction (PCR)18. Such monitoring efforts also provide potentially invaluable repositories, which would be available for study after future outbreaks in order to reconstruct an outbreak's origin, and as a source of relevant reagents.

CDC is unique in its ability to solve these zoonotic diseases

DHHS, Department of Health and Human Services, 2002
[“Protecting the Nation’s Health in an Era of Globalization: CDC’s Global Infectious Disease Strategy,” prepared by the Dept of Health and Human Services, http://www.cdc.gov/globalidplan /global_id_plan.pdf]
CDC can stimulate this process by providing technical assistance, evaluating regional progress, and working with WHO, other U.S. agencies, and other interested groups to strengthen the networks’ telecommunications capacities and encourage the use of common software tools and harmonized standards for disease reporting. CDC can also help revise the International Health Regulations, which describe internationally-reportable diseases and syndromes. In addition, CDC will encourage linkages between regional networks and veterinary surveillance systems that monitor illnesses and epidemics among agricultural and feral animals. Several major outbreaks of zoonotic diseases (diseases of animals that also affect humans) involving agricultural animals have occurred in recent years (Box 15). CDC will also support disease surveillance efforts in tropical or heavily forested areas that are likely sources of human infection with unknown zoonotic or vectorborne diseases.

Effective surveillance is key to detection and prevention of new super-diseases – the CDC is the only agency that can coordinate surveillance
Louis Jacobson, associate editor at National Journal, 1995
[“Disease Detectives,” National Journal, Government Executive, Section: Health, May, Lexis]
The U.S. governments disease-fighting forces have had some notable successes in the past, but they may lack the resources to combat the enemy's increasing strength. As an outbreak of drug-resistant cholera began to spread in the small west African nation of Guinea-Bissau last fall, two young epidemiologists from the U.S. Centers for Disease Control and Prevention boarded a plane and began reading up, feverishly, on a disease they knew little about. Their mission was to size up the outbreak and advise local health officials on how to attack it. As they read, Alex Rowe and Fred Angulo, members of the CDC's elite Epidemic Intelligence Service, found hints that acidity could kill the cholera bacteria. When they arrived in Guinea-Bissau, they checked out a hunch -- and, sure enough, found that people who spritzed lemon in their water were less likely to become ill. Rowe and Angulo told the health ministry that adding lemon juice to water seemed to work just as well as boiling it, and was less expensive. Impressed, the government kicked off a big awareness campaign, and eventually the outbreak died down. It was a small victory in an exhausting fight. For most of this century, science made unswerving progress in controlling infections. But in the past decade or so, previously unheard-of microscopic predators have begun to stalk humans with breathtaking impunity. Some of these "emerging infections" are new strains of microbes, such as tuberculosis, that have become resistant to the drugs that had once nearly vanquished them. Others, such as the E. Coli O157:H7 that found its way into undercooked Jack-in-the-Box hamburgers in 1993, are mutated versions of ordinarily benign organisms. Still others, like the deer-tick-borne Lyme disease, became worrisome only when humans upset fragile ecosystems, presenting rare microbes with many new victims. Some, such as hantavirus, blossomed naturally, aided in 1993 by a rare bumper crop of pinon nuts and the resulting boom in virus-carrying mice. And many, like AIDS, traversed the globe, aided by modern-day travel. Indeed, because any killer bug -- even a rare, exotic one from deepest Africa -- can immigrate to airports in New York or Dallas without presenting a passport or stopping at customs, agencies such as CDC now represent one of the last barriers between humans and the bugs that would infect them. The U.S. government sends "disease cowboys" like Rowe and Angulo to places like Guinea-Bissau out of self-interest as well as altruism. They test new treatments in the field, watch for new strains and track the travels of microbes from one country to the next. This last mission -- known as disease surveillance -- is especially vital, as it provides the United States and its neighbors with advance warning about disease threats. And it is in trouble. Systematic surveillance, especially on a global scale, has always been vexing. Findings are often haphazard: Not long ago, CDC learned of an outbreak of Lassa fever, an exotic, painful and often fatal virus, only because a supermarket pharmacist in Atlanta suggested that the agency check out an illness his brother was suffering in Nigeria. Today, though, the world's surveillance network faces unprecedented troubles. Neglect and budget cuts have crippled some parts of the safety net, and even CDC, the healthiest link, could prove unequal to the rising tide of infections. While the public's attention has been focused on the dangers of emerging infections by the hit movie Outbreak and the publication last year of several popular books and countless articles on the subject, the hype doesn't seem to be translating into real efforts to strengthen the ailing U.S. surveillance system. The Surveillance Challenge The need for good surveillance seems self-evident. "My main pitch," says Christopher H. Foreman Jr., author of Plagues, Products, and Politics (Brookings Institution, 1994), "is that surveillance is the one element in all these hazards that is essential. Surveillance is the one stage where professionals run the show and where there's relatively little controversy about what is right to do." Coordinating that surveillance, however, is a huge challenge. In the United States alone, epidemiologists must rely on physicians to notify local authorities about patients with unusual or serious infections. Local officials pass information up the ladder to state officials, who then tell CDC. Meanwhile, CDC has to coordinate with other federal agencies, notably the Agriculture Department (which handles animal and some food-borne diseases) and the military, whose far-flung outposts serve as sentinels for overseas outbreaks and whose research labs (thanks to longstanding concerns over biological warfare) rival and often surpass CDC's. Finally, the United States has to work with foreign nations and such umbrella groups as the World Health Organization to track global disease movements. Even if all the links were strong, creating a functioning whole would be challenging. But weaknesses abound. A study by Michael Osterholm, Minnesota's state epidemiologist, found that most states have no more than one person tracking all communicable diseases (excepting those whose tracking is supported by federal funds). Yet an association of state epidemiologists has just agreed to add half a dozen diseases to the list of roughly 50 upon which it is suggested that states report to the CDC.

Finally, future diseases cause extinction

Kavita Daswani, 1996
[South China Morning Post, 1/4, Lexis]
Despite the importance of the discovery of the "facilitating" cell, it is not what Dr Ben-Abraham wants to talk about. There is a much more pressing medical crisis at hand - one he believes the world must be alerted to: the possibility of a virus deadlier than HIV. If this makes Dr Ben-Abraham sound like a prophet of doom, then he makes no apology for it. AIDS, the Ebola outbreak which killed more than 100 people in Africa last year, the flu epidemic that has now affected 200,000 in the former Soviet Union - they are all, according to Dr Ben-Abraham, the "tip of the iceberg". Two decades of intensive study and research in the field of virology have convinced him of one thing: in place of natural and man-made disasters or nuclear warfare, humanity could face extinction because of a single virus, deadlier than HIV. "An airborne virus is a lively, complex and dangerous organism," he said. "It can come from a rare animal or from anywhere and can mutate constantly. If there is no cure, it affects one person and then there is a chain reaction and it is unstoppable. It is a tragedy waiting to happen." That may sound like a far-fetched plot for a Hollywood film, but Dr Ben -Abraham said history has already proven his theory. Fifteen years ago, few could have predicted the impact of AIDS on the world. Ebola has had sporadic outbreaks over the past 20 years and the only way the deadly virus - which turns internal organs into liquid - could be contained was because it was killed before it had a chance to spread. Imagine, he says, if it was closer to home: an outbreak of that scale in London, New York or Hong Kong. It could happen anytime in the next 20 years - theoretically, it could happen tomorrow. The shock of the AIDS epidemic has prompted virus experts to admit "that something new is indeed happening and that the threat of a deadly viral outbreak is imminent", said Joshua Lederberg of the Rockefeller University in New York, at a recent conference. He added that the problem was "very serious and is getting worse". Dr Ben-Abraham said: "Nature isn't benign. The survival of the human species is not a preordained evolutionary programme. Abundant sources of genetic variation exist for viruses to learn how to mutate and evade the immune system." He cites the 1968 Hong Kong flu outbreak as an example of how viruses have outsmarted human intelligence. And as new "mega-cities" are being developed in the Third World and rainforests are destroyed, disease-carrying animals and insects are forced into areas of human habitation. "This raises the very real possibility that lethal, mysterious viruses would, for the first time, infect humanity at a large scale and imperil the survival of the human race," he said.

Contention Three – Bioterror

African disease surveillance efforts are failing due to a lack of funding—this risks a global epidemic

James Thuo Njuguna, completing his PhD in medical parasitology at the University of Bonn, International Livestock Research Institute in Nairobi, 2005
[African Security Review Vol 14 No 1, http://www.iss.co.za/index.php ?link_id=3&slink_id=1967&link _type=12&slink_type=12&tmpl_id =3]
Terrorist groups exist to promote religious, ethnic, political (ideological) or economic causes. Acts of biological terrorism could therefore have political, religious, ideological or criminal motives and could conceivably be planned by groups or a single individual or be part of state-sponsored terrorist activities The activities leading to the 1998 American embassy bombings in Kenya and Tanzania were well coordinated and planned. This trend has continued with most recent attacks across the world. Various attacks are timed to take place simultaneously and on multiple targets. This indicates that terrorist groups make extensive plans for these activities. It is now known that the suspected perpetrators can be citizens of one or different countries, which demonstrates the capacity of these groups to successfully recruit members and execute plans undetected by law enforcement agencies. This was true of the events of 11 September 2001 in the United States. When compared to other weapons, the acquisition, storage and transportation of -biological weapons could be considerably easier. Competent undergraduate students could readily master viral, bacterial culture methods and simple genetic engineering. It is possible that a group or individuals with appropriate training could produce lethal weapons in adequate amounts and then disseminate them in a manner that would result in thousands of casualties and widespread panic. Outbreaks of infectious diseases are a common occurrence in eastern Africa and the region suffers from insecurity owing to countless conflicts. This makes the threat of the use of biological weapons in this region something that has to be considered by the relevant -government departments. In addition, the -distinction between national and global threats is artificial, as infectious agents do not observe the divide. Adequate public health surveillance and response are solutions to preparing for biological warfare events. Only long-term planning and funding can sustain such a global undertaking, which has to be internationally financed and managed. Infectious diseases with no known prophylactic remedies will continue to infect travellers and local people and remain a possible biological weapon.32 Infectious diseases can undermine the security of a country whether these diseases are deliberately inflicted by biological warfare or occur naturally. While the Biological and Toxins Weapons Convention (BTWC) prohibits the development and use of biological weapons, the defence against a natural or intentional epidemic is the same: a robust global public health surveillance system and the ability to respond efficiently and effectively to disease outbreaks. The state has an important role in combating the threat of deliberate disease because it has the moral duty to protect its citizenry. An effective way of countering the threat of deliberate disease is to establish and maintain disease surveillance and control programmes. Most of the publications on epidemics in eastern Africa indicate that very little disease surveillance is done at present.33 Where gains were made in control and eradication, they were later lost through neglect of control protocols such as vaccinations and control of livestock movements between endemic and non-endemic areas. There seems be unanimous agreement among observers that the main reason for the failure of surveillance and control systems is lack of funding. This is blamed on reduced funding for the responsible government organs and agencies owing to shrinking economies. National governments and other interested stakeholders will have to find the required funds, for if infectious diseases are not eradicated or at least maintained at minimum levels, an added threat will be their use as biological weapons, endangering people away from the endemic areas. Observers have expressed the view that disease surveillance should be intensified and coordinated beyond the divide of national boundaries. Surveillance programmes should be part of the public health management systems. The ideal situation requires setting up local and international surveillance/response teams. Teams endowed with the necessary techniques and resources should be put in place so that they can deal with epidemics when they occur. This will ensure that expertise in dealing with these diseases is available uniformly throughout the region.35 It is also important to register the groups/individuals engaged in these emergencies to minimise chances of hazardous materials being acquired by groups whose intent would be to cause disease outbreaks. Vaccination programmes have to be maintained because failure to do so may lead to a loss of the gains previously achieved in terms of disease control. Besides, for every case of sickness encountered, prevention is cheaper than cure. Some authors encourage joint veterinary and human disease surveillance as a way of cost cutting for zoonotic disease control and such a team can be schooled to monitor biological weapons as well (see the commentary by Dorothy Preslar in this issue of African Security Review).

Numerous factors make a biological terror attack on the continent highly likely

John Bornie, Leads a project on ‘Disarmament as Humanitarian Action’ at the UN Institute for Disarmament Affairs in Geneva, was New Zealand ’s deputy head of mission for disarmament in Geneva and working on biological disarmament issues, and Dominique Loye, Deputy Head of the Mines-Arms Unit of the International Committee of the Red Cross in Geneva, 2005
[“Why Preventing Hostile Use of the Life Sciences is Relevant to Africa,” African Security Review, Vol 14, No 1]
But why would African populations or economies be targets for attacks with biological agents? It is worth bearing in mind that African countries could be considered attractive targets for attack precisely because they are perceived (or these countries perceive themselves) as non-strategic or unimportant. For example, those with hostile intent might carry out such attacks as a demonstration of their power to other countries perceived as ‘strategic’ or as a means of creating a regional or global pandemic, hoping to overwhelm the disease response resources of developed countries. The chances of being caught could be much lower in African countries than in those with greater public health and law enforcement capabilities, or there may be a lower perception of threat, accompanied by a lower level of vigilance. Those with hostile intent may simply wish to attack foreign populations in African countries without regard for ‘collateral damage’ to the local people or their environment, as happened in the truck bomb attacks on American embassies in Kenya and Tanzania on 7 August 1998, which killed 225 people and injured more than 4 000. Sadly, the use of poisoning and the deliberate spread of infectious disease as a method of warfare is not a new concept in Africa. Historical examples abound, for example infecting the tips of arrows and contaminating wells. Modern examples include the use of chemical weapons by Mussolini’s armies in the invasion and annexation of Abyssinia (now Ethiopia) in 1936. Libya’s offensive biological, chemical and nuclear weapon programmes are only now being dismantled. Moreover, the apartheid government’s clandestine programme to develop biological and chemical weapons (‘Project Coast’) in South Africa until the 1990s experimented with a number of agents intended to kill opponents of apartheid and to develop so-called non-lethal agents for use against demonstrators and other civilians.20 A leading expert on ‘Project Coast’ concluded that: On a continent that has a great deal of experience of national conflicts, there is a potential incentive for acquiring [biological weapons]. We therefore need to be aware of the danger posed by the development of biological agents that can be used to quell civilian uprisings against bad governments.21 Africa has witnessed many destructive conflicts in the last half-century, some of which simmer on. The prospect cannot be excluded that certain African governments will view biological agents as attractive weapons against each other, as has happened in the past. Unless norms against poison and the deliberate spread of disease are strongly embedded in the region’s political culture through adherence to the relevant international treaties and practical and transparent risk reduction measures to build mutual confidence, the use of biological weapons is increasingly likely, as they are becoming cheaper and easier to develop.

Disease surveillance is essential to the prevention and containment of bioterror outbreaks—local health workers alone lack necessary skills

Effective surveillance provides valuable experience to contain and deter bioterror attacks

Bioweapons cause extinction

Richard Ochs, Freelance Journalist, 2002
[“Biological Weapons must be Abolished Immediately,” June 9, http://www.freefromterror.net /other_articles/abolish.html] Rein
Of all the weapons of mass destruction, the genetically engineered biological weapons, many without a known cure or vaccine, are an extreme danger to the continued survival of life on earth. Any perceived military value or deterrence pales in comparison to the great risk these weapons pose just sitting in vials in laboratories. While a "nuclear winter," resulting from a massive exchange of nuclear weapons, could also kill off most of life on earth and severely compromise the health of future generations, they are easier to control. Biological weapons, on the other hand, can get out of control very easily, as the recent anthrax attacks has demonstrated. There is no way to guarantee the security of these doomsday weapons because very tiny amounts can be stolen or accidentally released and then grow or be grown to horrendous proportions. The Black Death of the Middle Ages would be small in comparison to the potential damage bioweapons could cause. Abolition of chemical weapons is less of a priority because, while they can also kill millions of people outright, their persistence in the environment would be less than nuclear or biological agents or more localized. Hence, chemical weapons would have a lesser effect on future generations of innocent people and the natural environment. Like the Holocaust, once a localized chemical extermination is over, it is over. With nuclear and biological weapons, the killing will probably never end. Radioactive elements last tens of thousands of years and will keep causing cancers virtually forever. Potentially worse than that, bio-engineered agents by the hundreds with no known cure could wreck even greater calamity on the human race than could persistent radiation. AIDS and ebola viruses are just a small example of recently emerging plagues with no known cure or vaccine. Can we imagine hundreds of such plagues? HUMAN EXTINCTION IS NOW POSSIBLE.

Contention Four – Solvency

The CDC must expand its Global Disease Detection program to ensure effective global disease surveillance

Center for Disease Control, 2007
[“Professional judgment for fiscal year 2008”, developed in response to a request by the chairman, during the house appropriation Subcommittee on labor, health and human services, 4-20, http://www.fundcdc.org/document s/CDCFY2008PJ_000.pdf, p. 6]
CDC is a major partner in our nation’s frontline against emerging international health threats. CDC’s Global Disease Detection program, in partnership with host country governments and the WHO, is a key component of this effort and forms the foundation of a transnational detection, prevention and response network to address emerging health threats including pandemic influenza. With current funding levels, CDC has established 5 regional response Centers, but needs 18 – three in each WHO region - to complete the network and properly protect the nation. The existing Centers have already proven their effectiveness and impact on detecting and responding to outbreaks including avian influenza, aflatoxin poisoning, Rift Valley fever, Ebola and Marburg virus outbreaks, and many other serious infectious diseases and environmental health threats. The Centers also provide a platform for regional training, surveillance, research, and health diplomacy activities that help promote sustainable health development in the targeted regions. CDC is a major global source of technical and scientific support to categorical disease control programs supported by USG, WHO, health ministries, PEPFAR, the Global Fund, and many other health organizations. Our investment is modest and highly leveraged, but our capacity in most critical areas has been eroded by budget attrition and increases in the costs of science, travel, and infrastructure support in the past few years. We need to continue and expand operational research to assure that investments the USG and others are making in international health are state-of-the science and optimized to achieve results in the field. Critical areas that urgently need support include:

CDC's unique research and expertise means that the best and essential public health tools are used

The US is uniquely capable of surveillance – they have the best research and scientists and other countries will follow US leadership

Population Council, 1996
[“The National Science and Technology Council on Emerging and Re-emerging Infectious Diseases,” Population and Development Review, Vol. 22, No. 1, Match, JSTOR]
Thus, the effort to build a global surveillance and response system is in accord with the national security and foreign policy goals of the United States. Moreover, leadership in global infectious disease surveillance and control is a natural role for the United States. American business leaders and scientists are in the forefront of the computer communications and biomedical research communities (both public and private sector) that provide the technical and scientific underpinning for disease surveillance. Furthermore, American scientists and public health professionals have been among the most important contributors to the international efforts to eradicate smallpox and polio. The challenge ahead outstrips the means available to any one country or to international organizations. The U.S. Government must not only improve its capacity to meet the growing threat of emerging infectious diseases, but also work in concert with other nations and international bodies. Although international efforts must be coordinated to prevent global pandemics, disease surveillance must be the responsibility of each sovereign nation. However, individual governments may not easily share national disease surveillance information, fearing losses in trade, tourism and national prestige. Nevertheless, because U.S. experts are often consulted on problems of infectious disease recognition and control, the U.S. Government is usually informed about major disease outbreaks in other countries, although not always in an official or timely fashion. To ensure that we continue to be notified when an unusual outbreak occurs, we must encourage and support other countries' efforts in national disease surveillance and respond when asked for assistance. We must strive to develop a sense of shared responsibility and mutual confidence in the international effort to combat infectious diseases. There is much room for optimism. If the United States takes the lead, we can expect that other nations will contribute resources to a global surveillance system. Both Canada and the European Union have recently decided- in spite of tight budgets-to provide substantial funds ($7 and $10 million per year, respectively) to strengthen infectious disease surveillance and control. It is also absolutely critical that developing nations be engaged in an international effort that is in their own interests. In May 1995, WHO passed a resolution urging member states "to strengthen national and local programmes of surveillance for infectious diseases, ensuring that outbreaks of new, emerging, and reemerging infectious diseases are identified." Soon after the resolution was drafted, WHO issued a report urging the strengthening of global disease surveillance and control, and encouraging greater use of WHO Collaborating Centers in this endeavor.

Disease surveillance is a prerequisite to all other forms of disease care – only disease surveillance can get at the problem quickly and provide information for treatment and containment

Mac W. Otten, Jr., MD, MPH, Medical Epidemiologist, African Regional Office (WHO) and Helen Perry, MA, Educational Design Specialist, Division of International Health (CDC), 2001
[“Technical Guidelines for Integrated Disease Surveillance and Response in the African Region,”6/01, http://www.cdc.gov/idsr/focus /surv_sys_strengthening/tech _guidelines-integrated-diseaseE NG.pdf]
Communicable diseases are the most common causes of death, disability and illness in the African region. While these diseases present a large threat to the well-being of African communities, there are well-known interventions that are available for controlling and preventing them. Surveillance data can guide health personnel in the decision making needed to implement the proper strategies for disease control and lead to activities for preventing future cases. Surveillance is a watchful, vigilant approach to information gathering that serves to improve or maintain the health of the population. A functional disease surveillance system is essential for defining problems and taking action. Using epidemiological methods in the service of surveillance equips district and local health teams to set priorities, plan interventions, mobilize and allocate resources and predict or provide early detection of outbreaks. Depending on the goal of the disease prevention programme, the surveillance activity objectives guides programme managers towards selecting data that would be the most useful to collect and use for making evidenced-based decisions for public health actions. A disease control program may want to know what progress is being made with its prevention activities. The program collects age and vaccination statues for cases of vaccine-preventable diseases. If the program’s goal is to prevent outbreaks, the surveillance unit can monitor the epidemiology of a particular disease so that the program can more accurately identify where the next cases might occur or the populations at highest risk. In addition, improving laboratory support for disease surveillance is essential for confirming causes of illness and early detection of outbreaks. Casebased investigation and laboratory confirmation provide the most precise 2 information about where action must be taken to achieve an elimination target. Monitoring populations at highest risk for a particular disease can help to predict future outbreaks and focus prevention activities in the areas where they are most needed.

SS Disease surveillance Aff